It is desirable that our students be in the best health possible to meet the demands of the academic and physical education/ sports programs at the Academy of St. Paul.
All health and medical forms related to your child’s/children’s health are available for you to access online . All students must submit a current physical examination report. To be considered current, the physical examination is to be conducted after January 1, of the respective school year. If, due to insurance restrictions, your child’s appointment is delayed until after school begins in September 2020, please notify the Nurse directly at: (201) 327-1108 . The office is staffed by School Nurse, 8:30 AM to 2:30 PM, Monday through Friday. Please feel free to contact the nurse with any health concerns.
Health Assessment and Medical Examination Requirements
Please print and take ALL of the required forms listed below to your physician. Forms must be completed and signed as noted by parent or guardian AND physician and returned to the school no later than August 1.
| 1. Personal and Family History |
5. Allergy/Anaphylaxis Emergency Care Plan (i f applicable) |
| 2. Physical Examination Report (eye and hearing examinations should be included). Universal | 6. Consent for Administration of Epinepherine via Auto- Injector by a Delegate (if applicable) |
| 3. Immunization Record | 7. Asthma Treatment Plan (if applicable) |
| 4. Authorization to Administer Medications | 8. Complete Dental Examination recommended each year. |
Please note: Allergic/Anaphylaxis Care Plan and Asthma Plan forms are only for children with treatment plans for allergic reactions or asthma. These must be updated annually by your physician.
Please print and take ALL of the required forms listed below to your physician. Forms must be completed and signed as noted by parent or guardian AND physician and returned to the school no later than August 1.
| 1. Personal and Family History |
5. Allergy/Anaphylaxis Emergency Care Plan (i f applicable) |
|
2. Physical Examination Report Grade 3: (eye and hearing exams should be included); Grades 4-8: (eye examinations and hearing exams MUST be included) |
6. Consent for Administration of Epinepherine via Auto- Injector by a Delegate (if applicable) |
| 3. Immunization Record | 7. Asthma Treatment Plan (if applicable) |
| 4. Authorization to Administer Medications | 8. Complete Dental Examination recommended each year. |
Please note: Allergic/Anaphylaxis Care Plan and Asthma Plan forms are only for children with treatment plans for allergic reactions or asthma. These must be updated annually by your physician.
Athletic Preparticipation Physical Examination (PPE) and Health History Questionnaire (HHQ)
**Please read i nstructions for completing the PPE or Health History Questionnaire (HHQ). (See: left margin)
If your child will participate on an athletic team, please note a current Preparticipation Physical Evaluation (PPE) form must be on file in the nurse's office prior to the beginning of practice.
If the PPE has been performed 90 days prior to the first day of practice in an athletic season, then the updated HHQ is required. A physician does not have to complete the HHQ.
IMPORTANT NOTE: Students WILL NOT be allowed to participate in pre-season practice or season games until all required medical forms are on file in the nurse’s office.
1. Archdioces of Newark CYO Athletics Waiver/Code of Conduct (4 pages)
2. Sports Related Concussion Fact Sheet- sign off form (1 page)
3. Sports Related Eye Injury Fact Sheet
4. Sudden Cardiac Death Sheet-sign off form (1 page)